Friday, August 30, 2013

Increased Risk of Physical and Psychological Effects of Trauma in Civil War Vets

From K. Kris Hirst

Using open source data from a federal project digitizing medical records on veterans of the American Civil War (1860-1865) called the Early Indicators of Later Work Levels, Disease, and Death Project, researchers have identified an increased risk of post-war illness among Civil War veterans, including cardiac, gastrointestinal, and mental diseases throughout their lives. In a project partly funded by the National Institutes of Aging, military service files from a total of 15,027 servicemen from 303 companies of the Union Army stored at the United States National Archives were matched to pension files and surgeon's reports of multiple health examinations. A total of 43 percent of the men had mental health problems throughout their lives, some of which are today recognized as related to post-traumatic stress disorder (PTSD). Most particularly affected were men who enlisted at ages under 17. Roxane Cohen Silver and colleagues at the University of California, Irvine published their results in the February 2006 issue of Archives of General Psychiatry.

Studies of PTSD to date have connected war experiences to the recurrence of mental health problems and physical health problems such as cardiovascular disease and hypertension and gastrointestinal disorders. These studies have not had access to long-term health impacts, since they have been focused on veterans of recent conflicts. Researchers studying the impact of modern conflict participation report that the factors increasing risk of later health issues include age at enlistment, intimate exposure to violence, prisoner of war status and having been wounded.

The Trauma of the American Civil War

The Civil War was a particularly traumatic conflict for American soldiers. Army soldiers commonly enlisted at quite young ages; between 15 and 20 percent of the Union army soldiers enlisted between ages of 9 and 17. Each of the Union companies was made up of 100 men assembled from regional neighborhoods, and thus often included family members and friends. Large company losses--75 percent of companies in this sample lost between five and 30 percent of their personnel--nearly always meant the loss of family or friends. The men readily identified with the enemy, who in some cases represented family members or acquaintances. Finally, close-quarter conflict, including hand-to-hand combat without trenches or other barriers, was a common field tactic during the Civil War.

To quantify trauma experienced by Civil War soldiers, researchers used a variable derived from percent of company lost to represent relative exposure to trauma. Researchers found that in military companies with a larger percentage of soldiers killed, the veterans were 51 percent more likely to have cardiac, gastrointestinal and nervous disease.

The Youngest Soldiers were Hardest Hit

The study found that the youngest soldiers (ages 9-17 at enlistment) were 93% more likely than the oldest (ages 31 or older) to experience both mental and physical disease. The younger soldiers were also more likely to show signs of cardiovascular disease alone and in conjunction with gastrointestinal conditions, and were more likely to die early. Former POWs had an increased risk of combined mental and physical problems as well as early death.

One problem the researchers grappled with was comparing diseases as they were recorded during the latter half of the 19th century to today's recognized diseases. Post-traumatic stress syndrome was not recognized by doctors--although they did recognize that veterans exhibited an extreme level of 'nervous disease' that they labeled 'irritable heart' syndrome.

Children and Adolescents in Combat

Harvard psychologist Roger Pitman, writing in an editorial in the publication, writes that the impact on younger soldiers should be of immediate concern, since "their immature nervous systems and diminished capacity to regulate emotion give even greater reason to shudder at the thought of children and adolescents serving in combat." Although disease identification is not one-to-one, said senior researcher Roxane Cohen Silver, "I've been studying how people cope with traumatic life experiences of all kinds for twenty years and these findings are quite consistent with an increasing body of literature on the physical and mental health consequences of traumatic experiences."

Boston University psychologist Terence M. Keane, Director of the National Center for PTSD, commented that this "remarkably creative study is timely and extremely valuable to our understanding of the long term effects of combat experiences." Joseph Boscarino, Senior Investigator at Geisinger Health System, added "There are a few detractors that say that PTSD [Post-traumatic stress disorder] does not exist or has been exaggerated. Studies such as these are making it difficult to ignore the long-term effects of war-related psychological trauma."
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